Until “Pre-hospital PCI” becomes a reality …this is not possible.

March 4, 2025 by dr s venkatesan

Is primary PCI superior to thrombolysis in the first hour of STEMI ?

No, it is not. I know, most interventional cardiologists cannot accept this fact and would strongly disagree. Still, they know very well there is no clear data to back up their belief. Even the ACC and ESC sort of failed to acknowledge the low quality of available evidence in this specific issue of reperfusion in the first hour.

The fact of the matter is, at best, pPCI fights for equipoise in the first hour, but thrombolysis is a clear winner in moral, scientifc & holistic perspective, as it can be administered very early, at a fraction of cost ,independent of expertise and infrastructure. (CAPTIM). Read ref 1, 2.

Final message

However , there is a thin streak of hope, untill, the unstoppable new generation Interventional cardiologists make “pre-hospital PCI“ a reality .Till then, pPCI will trail behind pre-hospital thrombolysis in the golden hour reperfusion race both in time and probably in efficacy as well.

Reference

1.Steg PG, Bonnefoy E, Chabaud S, Lapostolle F, Dubien PY, Cristofini P, Leizorovicz A, Touboul P; Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation. 2003 Dec 9;108(23):2851-6. doi: 10.1161/01.CIR.0000103122.10021.F2. Epub 2003 Nov 17. PMID: 14623806.

2.Bonnefoy E, Lapostolle F, Leizorovicz A, Steg G, McFadden EP, Dubien PY, Cattan S, Boullenger E, Machecourt J, Lacroute JM, Cassagnes J, Dissait F, Touboul P; Comparison of Angioplasty and Prehospital Thromboysis in Acute Myocardial Infarction study group. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002 Sep 14;360(9336):825-9. doi: 10.1016/S0140-6736(02)09963-4. PMID: 12243916.